| NPI | 1295154128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WI 174053030) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: WI 2957123) |
| Enumeration Date | 2014-04-08 |
| Last Update Date | 2014-04-08 |